The impact of diabetes on left ventricular filling pattern in normotensiveand hypertensive adults: The strong heart study

OBJECTIVES We sought to determine the effect of diabetes mellitus (DM) on l eft ventricular (LV) filling pattern in normotensive (NT) and hypertensive (HTN) individuals. BACKGROUND Diastolic abnormalities have been extensively described in HTN b ut are less well characterized in DM, which frequently coexists with HTN. METHODS We analyzed the transmitral inflow velocity profile at the mitral a nnulus in four groups from the Strong Heart Study: NT-non-DM (n = 730), HTN -non-DM (n = 394), NT-DM (n = 616) and HTN-DM (n = 671). The DM subjects we re further divided into those with normal filling pattern (n = 107) and tho se with abnormal relaxation (AbnREL) (n = 447). RESULTS The peak E velocity was lowest in HTN-DM, intermediate in NT-DM and HT-non-DM and highest in the NT-non-DM group (p < 0.001), with a reverse t rend seen for peak A velocity (p < 0.001). In multivariate analysis, E/A ra tio was lowest in HTN-DM and highest in NT-non-DM, with no difference betwe en NT-DM and HTN-non DM (p < 0.001). Likewise, mean atrial filling fraction and deceleration time were highest in HTN-DM, followed by HTN-non-DM or NT -DM and lowest in NT-non-DM (both p < 0.05). Among DM subjects, those with AbnREL had higher fasting glucose (p = 0.03) and hemoglobin A1C (p = 0.04). CONCLUSIONS Diabetes mellitus, especially with worse glycemic control, is i ndependently associated with abnormal LV relaxation. The severity of abnorm al LV relaxation is similar to the well-known impaired relaxation associate d with HTN. The combination of DM and HTN has more severe abnormal LV relax ation than groups with either condition alone. In addition, AbnREL in DM is associated with worse glycemic control. (J Am Coll Cardiol 2001;37: 1943-9 ) (C) 2001 by the American College of Cardiology.